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PATHOLOGY AND LABORATORY

PATHOLOGY AND LABORATORY. Pathology & Laboratory Format (80048-89356). Hematology and Coagulation Immunology Transfusion Medicine Microbiology Infectious Agent Detection Anatomic Pathology Cytopathology Cytogenetic Studies Surgical Pathology Transcutaneous Procedures

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PATHOLOGY AND LABORATORY

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  1. PATHOLOGY AND LABORATORY

  2. Pathology & Laboratory Format(80048-89356) • Hematology and Coagulation • Immunology • Transfusion Medicine • Microbiology Infectious Agent Detection • Anatomic Pathology • Cytopathology • Cytogenetic Studies • Surgical Pathology • Transcutaneous Procedures • Reproductive Medicine Procedures • Organ or Disease Panels • Drug Testing • Therapeutic Drug Assays • Evocation/Suppression Testing • Consultation (Clinical Pathology) • Urinalysis • Chemistry

  3. Pathology & Laboratory FormatOrgan or Disease Oriented Panels • The services in the Pathology & Laboratorysection include laboratory testsonly. The collection of the specimen is coded separately from the analysis of the test. Example:If a patient had a technician in a clinic laboratory withdraw blood by means of a venipuncture of the arm, and the blood sample was then analyzed in the laboratory, you would code 36415for the venipuncture in addition to a code to report the test performed on the blood.

  4. Pathology & Laboratory SubsectionOrgan or Disease Oriented Panels80047-80076 • Code in subsection are grouped according to the usual laboratory work ordered by a physician for the diagnosis of or screening for various diseases or conditions. Examples • Basic metabolic panel - 80048 • General health panel - 80050 • Electrolyte panel - 80051

  5. Rules of Panels • All tests must have been conducted • Do not use -52, Reduced Service • Additional tests, over those in panel, reported separately • If all tests in the panel are not done: • List each test separately • Do not use panel code

  6. Pathology & Laboratory SubsectionOrgan or Disease Oriented Panels80047-80076PERFORMANCE EXERCISE • Hepatic function panel code. 80076 • Lipid panel 80061

  7. Drug Testing (80100-80103) • Laboratory Drug Test is done to Identify presence or absence of drug. • Testing that determines the presence or absence of a drug is qualitative. • When the presence of a drug is detected in the qualitative test, a confirmation test is usually performed by using a second testing method. • Code 80102 is used to describe this confirmation test.

  8. Drug Testing (80100-80103) • Code from the Therapeutic Drug Assay & Chemistry subsection are used to further identify the exact amount of the drug that is present (quantitative) • EXAMPLE: A patient who has been on a medication for a long time might need to undergo testing to determine whether the drug level is therapeutic.

  9. Drug Testing • Chromatography procedure in which multiple drugs identified: • Some machines identify all drugs present in one procedure • Others require two procedures or more to identify two or more drugs

  10. Drug Testing • Code the number of procedures, not the number of drugs tested: Examples • Two procedures to identify three drug = 80100 × 2 • One procedure to identify three drugs = 80100

  11. Drug Testing • Does not identify amount of drug present • Only presenceor absence(qualitative) • Report presence& amount (quantitative) • Therapeutic Drug Assays (80150-80299) • Chemistry (82000-84999)

  12. Therapeutic Drug Assays (80150-80299) • Material examined can be from any source • Drugs listed by generic names Example:amitriptyline (generic name for brand name Elavil) • PDR is a must for coding drug testing

  13. Therapeutic Drug Assays (80150-80299)PERFORMANCE EXERCISE • Confirmation of cocaine (qualitative) 80102 • Identify the amount of digoxin in the blood (quantitative) 80162

  14. Evocation/Suppression Testing (80400-80440) • Measures stimulating (evocative) or suppressing agents • Codes report only TC (Technical Component) of service

  15. Evocation/Suppression Testing (80400-80440) • Additional services to be reported • Supplies and/or drugs used in testing (99070 or HCPCS code) • Physician-administered agent • Infusion or Injection code (90780 and 90781) • E/M for physician monitoring of testing

  16. Consultation (Clinical Pathology) (80500-80502) • There are two codes under this subsection reserved for clinical pathology consultation. • These consultations are based on whether the consultation is limited or comprehensive. • Limited: Done without the pathologist review of the patient’s medical record • Comprehensive: Done with review of medical record as part of the consultation service.

  17. More Consultation Codes • Pathology Consultations during surgery are provided to examine tissue removed from a patient during a surgical procedure. • If the pathologist did not use a microscope to examine the tissue, report code 88329. • If a microscope was used to examine the tissue, report 88331 or 88332, depending on the number of samples that were examined

  18. Pathology Terminology • A Specimen:Sample of tissue of suspect area • A Block:Frozen piece of specimen • A Section:Slice of frozen block • A pathologist prepares a specimen by cutting it into blocks and taking sections from the blocks. • The number of sections taken depends on the judgment of the pathologist as to the number of areas of the specimen that need to be examined. • The frozen sectionis placed on a slide or held by other means that allow the pathologist to view the tissue under a microscope.

  19. Pathology Terminology • Each specimen may be reported separately, but each slide from that specimen may not. Example:Pathologist consults during surgical procedure • Examines 1 block =88331 • Examines 2nd section of same block = 88332

  20. Urinalysis (81000-81099) • Non-specific Tests on Urine • Method of test: • Examples:Tablet, reagent, or dipstick • Reason for test: • Example: Pregnancy • Constituents being tested: • Examples:Bilirubin, glucose

  21. Urinalysis • Equipment used • Automated or nonautomated • Number of tests performed

  22. Chemistry (82000-84999) • Specific tests on any bodily substances • Urine • Blood • Breath • Feces • Sputum

  23. Chemistry • Codes used mostly for qualitative (presence) screenings only • Four codes report quantitative (amount) screenings (80100-80103)

  24. Chemistry • Samples from different sources reported separately Examples: Blood, feces • Samples taken different times of day reported separately

  25. Urinalysis & Chemistry (80100-84999)PERFORMANCE EXERCISE • An automated urinalysis without microscopy. 81003 • Uric acid, blood 84550

  26. Hematology & Coagulation (85002-85999) • Laboratory procedures on blood Examples • Complete blood count (CBC) • White blood cell count (WBC) • Codes divided based on: • Blood draw • Test being conducted

  27. Hematology & Coagulation (85002-85999)PERFORMANCE EXERCISE • Blood count by automated hemogram (TBC, WBC, Hgb, Hct, and platelet count) 85027 • Automated RBC 85041

  28. Immunology (86000-86849) • Deal with identifying immune system conditions caused by antibodies & antigens Example:Hepatitis C antibody screening • PERFORMANCE EXERCISE • ANA (antinuclear antibody) titer 86039

  29. Transfusion Medicine (86850-86999) • Blood Bank Codes • Tests performed on blood or blood products • Does NOT identify supply of blood, but • Collection • Processing • Type • PERFORMANCE EXERCISE • Irradiation of blood product, 3 units 86945 x3

  30. Microbiology (87001-87999) • Study of Microorganisms • Identification of organism • Sensitivities of organism to antibiotics • Many code descriptions are similar to those in Immunology(86000-86849) • The difference is the technique used

  31. Microbiology (87001-87999)PERFORMANCE EXERCISE • Quantification of HIV-1, herpes, and Candida species. 87536 – HIV-1, quanfification 87530 – Herpes simplex 87482 - Candida species • Bacterial culture of urine, quantitative with colony count. 87086

  32. Anatomic Pathology (88000-88099) • Postmortem Examinations • Autopsies • Reports only physician service • Codes divided on extent of exam Example: • With or without central nervous system

  33. Cytopathology (88104-88199) • Identifies cellular changes • Common laboratory procedures Example: Pap smear • Codes divided on • Type of procedure • Technique used

  34. Cytogenetic Studies (88230-88299) • Branch of genetics concerned with cellular abnormalities & pathologic conditions • Cytogenetic Studies include tests performed for genetic and chromosomal studies.

  35. Surgical Pathology (88300-88399) • Evaluation of specimens to determine pathology of disease processes. • All tissue removed during procedures undergoes pathologic evaluation

  36. Surgical Pathology • This subsection contains codes that are divided into six levels based on the specimen examined and the level of work required by the pathologist • Level I – code 88300 identify specimens that normally do not need to be viewed under a microscope for pathologic diagnosis. • Level II – code 88302 deals with tissues that are usually considered normal tissue and have been removed, not because of the presence of disease or malignancy, but for reasons such as “fallopian tubes for the sterilization”.

  37. Surgical Pathology • Level III - code 88304 is assigned for specimen with a low neoplastic probability of disease or malignancy. • Level IV – code 88305 carries a higher probability of malignancy or decision making for disease pathology. • Level V - code 88307 classifies more complex pathology evaluation. • Level VI - code 88309 includes examination of neoplastic tissue or very involved specimens.

  38. Surgical Pathology (88300-88399)PERFORMANCE EXERCISE • The specimen is a uterus, tubes, and ovarian. The procedures was an abdominal hysterectomy for ovarian cancer. 88309 • The specimen is the prostate. The procedure was transurethral resection of the prostate. 88305

  39. Types of Pathologic Examination • Microscopic: With microscope • Gross:Without microscope • 88300, Only gross exam code • Others gross & microscopic

  40. Not Included in Codes 88300-88309 • Any special services necessary during specimen examination: Example:Special Stains • Additional services reported separately (88311-88399)

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